Posts Tagged ‘treatment’

Enuresis Causes

Tuesday, July 27th, 2010

EM writes, What exactly causes enuresis?

Enuresis is the medical term for bedwetting and is defined as the involuntary passage of urine in the night by children older than 5 or 6 who should have developed nighttime dryness. About 90% of children have always had bedwetting, also know as primary enuresis. The other 10% have had at least 6 months of dryness, then resume wetting, which is known as secondary enuresis. We know that bedwetting is inherited and that the chance of a child bedwetting is 44% if one parent had bedwetting, up to 77% if both parents had bedwetting.

There is no single, simple cause for enuresis. Some factors that play a role in bedwetting are:
-Decreased arousal from sleep in response to a full bladder
-Small bladder capacity
-High nighttime urine production
-Constipation
-Other factors, such as evening fluid loading, medications, attention problems, urinary problems, sleep apnea

Since there no single cause, looking at multiple factors is important. Bedwetting alarms address the decreased arousal from sleep by helping your child to develop the ability to wake to a full bladder. Small bladder capacity may change as your child grows older but bladder “stretching” exercises do not seem to speed up this process. High nighttime urine production may be adjusted by drinking earlier in the day. The other factors listed above can be looked at by your health care provider if you have concerns for your child.

The biggest thing to remember is that your child is not wetting on purpose and primary enuresis is seldom due to emotional or psychological issues. Being supportive and offering a solution such as a bedwetting alarm when your child is ready is a good way for parents to help their child stop bedwetting.

Best Moisture Alarms

Tuesday, July 13th, 2010

BW writes, My son’s pediatrician recommended a moisture alarm to help with my son’s bedwetting. What exactly is a moisture alarm and how do these urinary bed alarms work?

Your pediatrician is most likely referring to a bedwetting alarm, which is a device that senses moisture and then alerts the user and family that the wetting is occurring. The best moisture sensing alarms are ones which:
* Are placed where the wetness is most likely to occur (which is different for boys and girls)
* Are comfortable to wear
* Are durable and easy to clean
* Are loud enough for parents to hear (since children may sleep through the sound initially)

Our most popular moisture alarms (bedwetting alarms) are the wearable models, such as the Malem Ultimate or Malem Wireless. The moisture sensor is attached to the outside of your son’s own underwear. The Rodger Wireless has specialized briefs that sense the moisture. We also carry a couple pad type alarms, although these are a little less sensitive to small amounts of moisture.

Moisture alarms work by sounding and/or vibrating to alert you that the wetting is occurring. The next step is to turn off the alarm and walk to the bathroom. Over time, the brain begins to make the association to stop the flow of urine and get out of bed to urinate. Eventually, your son will be alerted to the feeling of a full bladder and get up before the alarm sounds or hold his urine until morning.

This whole process is quite amazing and it can end bedwetting in a matter of weeks instead of years of waiting for him to “grow out of it”.

Bed Wetting Medication

Wednesday, March 10th, 2010

My son is 8 and wets every night. My doctor mentioned that he can prescribe a medication to help. I’m a little nervous about giving my son medicine for this. Can you tell me more?
The most frequently prescribed medication for bedwetting is DDAVP (desmopressin). This synthetic form of the natural hormone vasopressin decreases the quantity of urine produced for the next eight to 12 hours. It begins to work quickly, usually within one hour of taking it. This medication is designed to curb bedwetting by making the urine more concentrated and decreasing the total amount of urine produced that night.

Medication often has immediate results, but when you stop it, the relapse rate is high-about 80 percent. DDAVP allows about half the children who use it to sleep dry that night, which makes it particularly useful for sleepovers and camps. DDAVP is available in two forms: a nasal spray and tablet. The tablet is now preferred because it delivers a more consistent and convenient dose. The nasal spray has a Black Box Warning because of some reported cases of seizures and death because of water intoxication. Also, children with allergic congestion can get erratic results with the nasal spray.

Dosage of DDAVP must be individualized, with one to three tablets (0.2 mg.) each night before bed as the recommended dose. The greatest number of dry nights is achieved by 0.4 to 0.6 mg. nightly. If your child is taking the medication for a situation outside of his home, such as sleepover camp, start it ahead of time to establish the appropriate dose. Your child’s doctor or nurse practitioner is responsible for determining your child’s dosage, but the general recommendation is as follows:
• If your child wets when taking one tablet, increase it to two.
• If wetting occurs with two tablets, his dosage should be three tablets.
• Three tablets is the maximum amount recommended for any age group.

DDAVP is generally safe with few side effects. Reported side effects include headache, stomach ache or water intoxication if a large amount of water is ingested after taking it. The manufacturer provides fluid guidelines, recommending no more than four ounces of water before bedtime. This medication can be safely used for three- to six-month intervals with a one week break. If wetting persists, it can be used for another interval. DDAVP is expensive, as much as $3-4 per tablet. The cost should be taken into account when considering long-term use.

DDAVP does not stop wetting in every child. Increasing the length of time taken will not make it work. The expected results should be seen in a week or two. Parents should realize that this medication does not provide long-lasting effects, but it does provide short-term dryness for many children. For long lasting results, getting to dryness by using a bedwetting alarm has a more permanent response.

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